[Clinicopathological features of transfusion-associated graft-versus-host disease]

The pathophysiology and clinical features of TA-GVHD are reviewed. Engrafted donor derived lymphocytes in TA-GVHD mainly target the immune system, i.e. myeloid and lymphoid as a result of recognition of "foreign" recipient transplantation antigens. The pathophysiology of acute GVHD has been described as a "cytokine storm" at the barrier of the immunobiological defence in the skin, liver, and intestine. TA-GVHD is mostly an acute syndrome, and predominantly associated with a pan-cytopenia, severe immunosuppression, a skin eruption, hepatitis, and gastrointestinal dysfunction, clinically manifested nausea, vomiting and diarrhea. The overall risk of TA-GVHD is unknown and is probably higher than the approximately 300-350 cases reported in the literature. TA-GVHD is often unrecognized in the setting of complex medical situations, where target organs are already dysfunctional. Furthermore, incomplete manifestations of the triad of GVHD may be present, or the syndrome may be mild or atypical. Finally, the potential diagnosis may be missed. We present an atypical case of fatal TA-GVHD in an immunocompetent diabetic patient after CABG operation, showing leukocytosis throughout the clinical course.